Welfare, Choice and
Solidarity in Transition
Reform of the welfare sector
is an important yet difficult challenge for all countries in transition from socialist
central planning to market-oriented democracies. Here a scholar of the economics of
socialism and post-socialist transition and a health economist take on this challenge.
This book offers health sector reform recommendations for ten countries of Eastern Europe,
drawn consistently from a set of explicit guiding principles. After discussing
sector-specific characteristics, lessons of international experience, and the main set of
initial conditions, the authors advocate reforms based on organized public financing for
basic care, private financing for supplementary care, pluralistic delivery of services,
and managed competition. Policymakers need to achieve a balance, both assuring social
solidarity through universal access to basic health services and expanding individual
choice and responsibility through voluntary supplemental insurance. The authors also
consider the problems that undermine effectiveness of market-based competition in the
health sector.
Reviews
To judge from its title,
Janos Kornai and Karen Eggleston have written a book about health care reform in Eastern
Europe. In fact, they have done much more. Following their own axiom of transparency, they
begin by setting out goals of health care and other social support systems in a fresh way,
and go on to apply the goals to the practical tasks of health care financing and
organization. In so doing, they make a large contribution to a small literature, a
comparative analytical treatment of many countries' health care systems together with
advice for the would-be reformer.
Joseph P. Newhouse, John D.
MacArthur Professor of Health Policy and Management, Harvard University
A book bringing together a
lifelong student of socialism and a highly-trained health economist was likely to produce
either a major disconnect or to provide intellectual fireworks through novel ways of
dissecting the issues and provocative insights into old problems. Lovers of fireworks
should read on.
Nicholas Barr, Reader in
Economics, London School of Economics and Political Science
(It) gives the reader a
number of provocative insights into the health care challenges of the coming decade in
Eastern Europe.
Health Affairs
The authors' intrinsic
knowledge of the political economy of transition countries, their profound understanding
of the historic context of the region, and their comprehensive approach to this rather
complex topic make the work especially valuable for decision-makers and opinion leaders in
Europe. In this context, the book fills a considerable void.
Health Affairs
Contents
Part I. Points of Departure
1. The general principles of
reform
2. The characteristics of the
health sector
3. Some international
experiences
4. The health sector in
Eastern Europe: the initial state
Part II. Guidelines for
Reform
5. The demand side:
financing, benefits, and organization of insurance
6. The supply side: delivery
system ownership, organization, and contracting
7. The interaction of supply
and demand: pricing, payment, hard budget constraints, and overall health-sector
development
8. Concluding remarks
365 pages